Child Health in Nigeria: Past, Present, and Future*

Arch Dis Child: first published as 10.1136/adc.61.2.198 on 1 February 1986. Downloaded from Archives of Disease in Childhood, 1986, 61, 198-204 Contemporary history Child health in Nigeria: past, present, and future* O RANSOME-KUTI College of Medicine, University of Lagost I looked at the list of former Windermere lecturers The historian of the Nigerian health services, and realised the great honour conferred on me by Ralph Schram, comments: 'Lugard undoubtedly felt being invited to give this lecture. It is also a tribute that the advances were wonderful, but for 9-5 to the vigour of Nigerian paediatrics and paediatri- million Africans in Nigeria, the day of excellent cians, whose frustrations and achievements form the hospitals and improvements in sanitation were still major part of this lecture, and to those paediatri- far off.'1 cians, mostly your members, who set us on our Dr I L Oluwole began the first school health path-Dick Jelliffe, the late Bob Collis, Arthur services in Lagos in 1925, and maternal and child Tompkins, Ralph Hendrickse, David Morley, Hugh welfare services were established in the rural areas, Jolly, the late Bruno Ganz, the late Richard Dobbs, mostly by missionaries, around 1926. One of the and Bob Prosser, to name a few-and to those of earliest was in Ilesha, where, many years later, you in this country who have inspired, taught, and Professor David Morley carried out his historic supported us in our gigantic struggle to improve the studies. In the 1920s it was noted that deliveriescopyright. health of our children. often took place on the mud floor. The rooms were Before the arrival of paediatrics in Nigeria in dark, smokey, and overcrowded. The deliveries 1952, children were given scant attention. The were supervised largely by grandmothers, who often earliest health services were provided for sailors and introduced puerperal sepsis. The babies were left slaves. Malaria took a heavy toll of the lives of unattended until the third stage of labour, with explorers and missionaries who ventured inland, but oozing cords open to infection from tetanus, a risk and dedicated to increased the cord with cow the latter were the most persistent only by dressing dung. http://adc.bmj.com/ providing services for the indigenes. The govern- In 1930 consciences were stirred in Britain about ment services were developed mainly to care for the health of mothers and children in Nigeria, and European civil servants and army personnel and Dr Mary Blacklock was sent out by the Leverhulme were also preoccupied with eradicating malaria and Research Foundation to investigate 'certain aspects improving sanitation. From 1900 onwards small of the welfare of women and children in the hospitals and dispensaries were in evidence in towns colonies', but little action was taken. In 1931 a with no medical missionary establishments. By 1925 report on health in colonial Africa stated that 'the Lord Lugard wrote: main factors which led to high infant and general on September 23, 2021 by guest. Protected 'The diseases of tropical Africa are comparatively few; mortalities are lack of sanitation, widespread inci- blackwater fever, malaria, dysentry and anaemia are the dence of debilitating diseases such as malaria, principal ones. Lung diseases, enteritis and cholera are helminth infections, schistosomiasis, and venereal rare or uncommon among Europeans. We have now, in diseases, lack of medical care, and dietetic deficien- the African Tropics, a most efficient medical service, and cies'. It is still so with a few more additions to generally speaking, excellent hospitals with an adequate today, nursing staff. To the skill of the doctors and the improve- the list. ments they have effected in sanitation etc, it is due that the Collecting of vital statistics became compulsory in returns of deaths and invalidings now show such a Lagos in 1863. More than a century later, however, wonderful decrease." important statistical data were rare, and the little information that existed was not properly used. For example, in 1952, Dr S L Adesuyi, a medical *Windermere Lecture, 1984, given at the 56th Annual Mccting of stressed the of hos- the British Paediatric Association. statistician, stupidity providing tSince giving this lecture Professor Ransome-Kuti has been pital beds almost exclusively for adults (90%) when appointed Minister for Health in Nigeria. children needed 40-50%. Moreover, the provision 198 Arch Dis Child: first published as 10.1136/adc.61.2.198 on 1 February 1986. Downloaded from Child health in Nigeria: past, present, and future 199 of beds for women was only 20% when about half of In 1981, in the rural areas of Bendel State, the patients were women. Akenzua found eight traditional midwives per 1000 Infant mortality for Lagos was stated to be 450 per population.5 Among other responses he received 1000 in 1900.1 Fifty years later it fell to 86 per 1000 from these midwives, 56% did not think it was and in 1973 it was reported at 70 per 1000 and 44-7 necessary to wash their hands and 36% the per 1000 by the United Nations Demographic Year perineum before delivery, and 20% would manage Book and the Federal Office of Statistics (Lagos), cases such as transverse lie and prolapsed cord and respectively. Because of the tremendous growth of 92% breech deliveries on their own. They are often the medical services and the prosperity of the people known to fail. Asked about the methods used to there has been a steady decline in infant mortality in resuscitate a baby who fails to cry at birth, the Lagos and perhaps throughout the Federation; answers varied from 'sprinkle alligator pepper on however, the method of reporting and collecting baby' (60%), to 'plug the anus with finger and pour data is such that the vital statistics for the nation are cold water on baby' (8%), and 'Nothing! It's God's still unreliable. wish' (4%). All of them were willing, however, to be More reliable data are available from surveys. trained in modern ways of midwifery and practice to The Rural Demographic Sample surveys carried out improve the quality of their service, and they are in 1965-6 give the country's infant mortality as 178 therefore a potential source of health manpower in per 1000, that of Lagos as 143 per 1000, and that of the rural areas. the former Western region and the former Federal In a provincial hospital in Ondo with no paediatric Territory as 79 per 1000. The surveys also reported a unit, intrapartum asphyxia due to prolonged child mortality (0-5 years) of 322 for boys and 306 labour was the commonest cause of the high for girls in rural Nigeria. Using age specific mor- perinatal mortality. Other causes were prematurity, tality, 40% of 1000 children born at year 0 will have twinning (16X4%), and congenital malformations. In died by the age of 5, most of these deaths occurring the University College Hospital, Ibadan, the causes in the first year. Data from our paediatric emerg- of high perinatal mortality were twinning (10% of all ency room at Lagos University Teaching Hospital pregnancies and also an important cause of pre- copyright. also indicated that infants (0-1 year) have the maturity), malpresentation, toxaemia, and the highest mortality among children admitted. tendency of women in Ibadan to have large With the opening of the first medical school in families.3 The women admitted to the hospital in Ibadan in 1948, paediatrics arrived in the country in Obadan were highly selective, and that hospital also the early 1950s. Health problems began to be had an excellent paediatric unit. defined mainly as they presented in hospitals, and Eighty per cent of babies are delivered in an solutions were found where it was possible. There unhealthy environment by unskilled attendants. In were, however, few community studies. hospitals or health centres they are discharged into http://adc.bmj.com/ At that time, the ratio of doctors to population the same contaminated environment within 48 was stated as 1:40 000. The desirable ratio for a hours. Ill babies pour from the community into country in the African region according to the hospital wards where facilities are most inadequate. World Health Organisation was 1:10 000. Nigeria In Lagos in 1981, 35% of newborn babies admitted was determined to achieve that ratio as soon as from the community were infected, 31-5% were possible in the hope that health care would thus be preterm, and 19-5% jaundiced. Moreover, 1021 available to all. It did so in 1980, by which time 13 jaundiced babies were treated as outpatients, 677 of on September 23, 2021 by guest. Protected medical schools were functioning. The health of our whom received exchange transfusions. Similar ex- children, however, has hardly improved. periences have been reported from Ibadan and other centres. Neonates Five conditions account for 76% of neonatal deaths in hospital-jaundice, infection, congenital The high perinatal mortality attests to the poor malformations, tetanus, and low birth weight quality of our obstetric care-45-6 per 1000 in (ranging from 21-3% in the North6 to 7-3% in Lagos,2 60-7 per 1000 in Ibadan,3 and 52 3 per 1000 Lagos,7 for babies born in hospital). Infections, in Ife.4 These hospital data (except the data for including tetanus, are the major causes of death. Lagos, which are for the whole city) include the Except for congenital malformations, all the outcome of deliveries attended in the early stages by conditions stem from factors in the environment. traditional midwives and brought to hospital when Neonatal jaundice is more severe in babies they go wrong.

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